Authors: Andre Chou, Ella Harrison-Hansley / Editor: Thomas MacMahon / Reviewer: Sarah Gooding / Codes: DC8, DP1, DP2, MuP4, SLO5 / Published: 11/03/2024

KC is a 15-month-old girl who arrives in your Emergency Department (ED) with her mother. For the past 2 days her mother has noticed a rash on both her legs spreading toward her trunk.

On examination, it is papular, firm and non-blanching. Aside from a mild fever, KC appears well. She has no significant medical history and her immunisations are up to date. Early stages of chicken pox are suspected so they are discharged with antipyretics, calamine and a leaflet on childhood fevers.

The next morning, they return because her legs and feet are puffy. On examination, KC still looks well, but now has bilateral ankle and foot oedema. The rash has not spread any further (see picture). Her chest is clear and abdomen is soft to palpation. Her ears and tonsils are red. She is walking but her legs are sore.

Her observations are within normal limits for her age.

Routine blood tests show normal renal function and full blood count, with a CRP of 24 (normal <5). Her urine dipstick shows +1 leucocytes and blood.